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Womb transplants give hope to women born without a uterus

Hopeful mothers who are born without wombs or have lost their wombs due to cancer or disease are hailing a new procedure

Women who are diagnosed with a uterus that is congenitally absent and those who have undergone a hysterectomy are considered to be “unconditionally infertile”-or described as having a form of infertility known as AUFI (absolute uterine factor infertility).

The only two options these women have to parent a baby are surrogacy or adoption. Now, though, women are able to choose a remarkable third option: the transplantation of the womb of another female to become fertile again.

The world’s first womb-transplant baby

The world’s first womb-transplant baby, Vincent, was born in October last year to a 36 year old Swedish woman who discovered at age 15 she was born without a womb; a condition known as Rokitansky syndrome. A 61 year old close family friend, who had already gone through menopause, donated her womb to the 36 year old.

According to the medical journal, The Lancet, the 36 year old recipient underwent in-vitro fertilization one year after her uterine transplant. She became pregnant after her first single embryo transfer. After developing pre-eclampsia during her pregnancy, the 36 year old recipient delivered a premature but healthy baby boy, named Vincent, by caesarian section.

The uterine transplant procedure performed by Dr. Mats Brannstrom, a Swedish physician and professor from the University of Gotenborg, has been compared in stature and significance to the world’s first heart transplant.

The successful procedure gave Dr. Brannstrom hope to go one step further by using the wombs of dead donors, as reported by the Daily Mail. Dr. Brannstrom plans on stripping the wombs of their cells and then regenerating them by coating them with live stem cells from the recipient’s body.

Using stem cells from the mother, an exact match, would be a significant step. It would reduce or eliminate the need for long-term immune-suppressing drugs, currently needed to prevent rejection of the live donor’s womb.

As reported by James Gallagher with BBC News, the birth was a joyous moment for Dr. Brannstrom:

“That was a fantastic happiness for me and the whole team, but it was an unreal sensation also because we really could not believe we had reached this moment.”

“Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility.”

Researchers have made great leaps into the science of regenerative medicine with many different types of organs. According to Smithsonian, it won’t be long before full organ transplants, such as livers, lungs and hearts, will be grown in a laboratory, made to order.

Mother-daughter womb swap

One month later, two more women delivered healthy babies from the transplanted wombs of their mothers, donated to allow their daughters to become fertile. The impact of a mother-daughter womb transplant is significant.

One womb will link three generations together. To a woman who has lost her uterus due to cancer or disease – or if it is congenitally absent – her child can be born from a womb that has been handed down through a generation, a womb that has carried its very own mother.

Risks of uterine transplant

Uterine transplant is not without its risks and complications. One hurdle is determining who qualifies as a good candidate for the procedure. To be a good candidate for uterine transplantation, the woman should be of childbearing age, without a uterus and in good health. The patient must have a stable immune system, especially because she will be taking anti-rejection drugs once the transfer occurs and throughout the pregnancy.

Anti-rejection drugs are taken to avoid rejection of the uterus. But according to Dr. Brannstrom, as reported by Popular Science, they are only meant to be temporary since the powerful drugs can suppress the immune system, making the recipient prone to illness and infections.

The 36 year old Swedish recipient took triple anti-rejection drugs throughout her pregnancy to prevent rejection. Although three episodes of mild rejection occurred, they were successfully reversed with corticosteroids.

The pregnancy of a uterine transplant recipient is treated as a high risk pregnancy with organ rejection a strong possibility. There are also surgical risks to the donor, who can be any age as long as she has a healthy uterus. And the surgery is complicated.

Dr. Antonio Gargiulo, a specialist in infertility and reproductive surgery at Brigham and Women’s Hospital, told the Boston Globe, “A live donor would have to undergo a radical hysterectomy, which would remove a larger portion of the tissues surrounding the uterus than in a typical hysterectomy, so that those tissues could be connected with tissues of the recipient.”

“Such a surgery could cause excessive bleeding or injury to the bowel or the ureters, and could lead to an infection that could develop into sepsis,” he said.

Costs involved

For women who long to “naturally” carry their own child, the cost of a uterine transplant is stunning. Dr. Gargiulo estimates the costs of a uterine transplant could be as high as $300,000 in the U.S. Surrogacy is a major cost factor, ranging from $10,000-30,000, not including physician fees and vitamins.

However, surrogacy costs are just one part of the entire procedure. Although, that may soon change. In the future physicians may be using “refurbished” wombs from cadavers, which may cut down on costs of the procedure.

The other options for a woman with AUFI are adoption or surrogacy. Adoption of a newborn from a non-profit agency can cost $10,000-$25,000. Using a private adoption through an attorney can range even higher, costing from $8,000-$40,000. Compare that to surrogacy which can range from $10,000-30,000.

Insurance coverage is highly unlikely given the voluntary nature and the risks and complexity of the procedure. Especially, when surrogacy is a much less costly and safer option, where it is legal, that is- such as in the U.S.

The solutions are complex

Not all medical specialists willingly perform uterine transplants. Dr. James Grifo of New York University Medical School, sympathizes with women who might want a uterine transplant, as reported by NPR – yet he has decided to follow other less risky priorities, he said in an interview.

“I don’t think it’s a simple discussion by any stretch,” Grifo told NPR. “You know, when you’re the patient, then you fully understand the issues. When you’re just theoretically discussing these things, unless it actually hits home, I think you don’t really fully understand it.”

Dr. Liza Johannesson, of Sahlgrenska University Hospital in Gothenburg, said: “It is also really exciting to have your mother as a donor. It is a very nice gift to give to your daughter.”

Ultimately, womb transplants are not without their controversies. The hearts of hopeful mothers will always ache to carry their own children – and those who have mothers willing to donate are the lucky ones.

There are many issues to consider. There is the issue of risks to the donor and recipient, the type of donor-dead or alive, immunosuppressant drugs used, other options available, costs involved. It’s all so very interesting, though. They are doing so much with organ transplants these days. It truly is amazing.

Holy cow! Now you really want to have a baby to be able to invest in this cost. And yes, this is quite remarkable. I have never heard of this. How interesting and innovative. And what a great way for those people who have already passed this time in their life to help another. Thanks for this informative article.

As an obstetric nurse years ago, I pondered the idea if this could ever be a reality. I doubted it. Dr. Jaffe, thanks for sharing this fascinating story. The miracle of birth has always been close to my heart, but this is beyond miraculous to discover! Thanks for also including the side effects and the costs of this procedure to consider. This is certainly a blog article I will never forget reading about for years to come!

Dr. Silva, I agree-it is fascinating and also surreal. It has truly opened the door to women all over the world who are suffering from uterine infertility. What an amazing delivery you would of witnessed if this procedure was available years ago! Thank you for visiting!